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Oheneba Boachieadjei - One of the best experts on this subject based on the ideXlab platform.
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postoperative Blood Salvage and autotransfusion for adult spinal deformity a randomized controlled trial
Spine, 2020Co-Authors: Venu M Nemani, Curtis A Mina, Evan D Sheha, Thomas Ross, Han Jo Kim, Oheneba BoachieadjeiAbstract:Study design Randomized controlled trial. Objective The aim of this study was to determine whether postoperative Blood Salvage and autotransfusion versus traditional closed suction drainage reduces the rate of homologous Blood transfusions in patients undergoing surgery for adult spinal deformity. Summary of background data The use of intraoperative Blood Salvage has become commonplace in spine surgery; however, the collection and reinfusion of Blood drained from the wound postoperatively have not been employed routinely because of increased cost and questionable benefit. Methods Adult patients undergoing long posterior fusions were randomized to either a Blood Salvage and reinfusion system (OrthoPat - Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was Results Thirty-four patients were randomized into Group 1 and 36 patients into Group 2. There were no differences in preoperative or intraoperative parameters. Patients in Group 1 had higher hemoglobin levels on postoperative day (POD) 2 and POD 3 compared to those in Group 2. However, there was no significant difference in the percentage of patients requiring homologous Blood transfusion between the two groups (41% Group 1 vs. 60% Group 2, P = 0.17). Similarly a subgroup analysis in patients with estimated Blood loss >2000 mL also showed no difference in homologous Blood transfusion rates (67% Group 1 vs. 76% Group 2, P = 0.58). There were no differences in the rate or type of postoperative complications. Conclusion Postoperative Blood Salvage and reinfusion result in a higher hemoglobin level in the early postoperative period, but does not significantly reduce the need for homologous Blood transfusion. Level of evidence 1.
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post operative Blood Salvage and autotransfusion for adult spinal deformity a randomized controlled trial
Spine, 2019Co-Authors: Venu M Nemani, Curtis A Mina, Evan D Sheha, Thomas Ross, Oheneba BoachieadjeiAbstract:STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine whether post-operative Blood Salvage and autotransfusion vs. traditional closed suction drainage reduces the rate of homologous Blood transfusions in patients undergoing surgery for adult spinal deformity. SUMMARY OF BACKGROUND DATA: The use of intra-operative Blood Salvage has become commonplace in spine surgery; however, the collection and reinfusion of Blood drained from the wound post-operatively has not been employed routinely due to increased cost and questionable benefit. METHODS: Adult patients undergoing long posterior fusions were randomized to either a Blood Salvage and reinfusion system (OrthoPat - Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was less than 50cc over 4 hours, and drains were removed when output was minimal. Patients received autologous or homologous Blood transfusions when Hg 2000cc also showed no difference in homologous Blood transfusion rates (67% Group 1 vs. 76% Group 2, p = 0.58). There were no differences in the rate or type of post-operative complications. CONCLUSIONS: Post-operative Blood Salvage and reinfusion results in a higher hemoglobin level in the early post-operative period, but does not significantly reduce the need for homologous Blood transfusion. LEVEL OF EVIDENCE: 1.
Nicholas J Giori - One of the best experts on this subject based on the ideXlab platform.
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timing of tourniquet release in total knee arthroplasty when using a postoperative Blood Salvage drain
Journal of Arthroplasty, 2009Co-Authors: Brian Steffin, Emilia Greenriviere, Nicholas J GioriAbstract:The purpose of this study is to examine the effect of a postoperative Blood Salvage drain and timing of tourniquet release on the maximal hematocrit drop after total knee arthroplasty. Thirty-seven total knees were prospectively randomized into either an early or late tourniquet release group. Hematocrit drop and drainage amounts were recorded. We found no significant difference in maximal hematocrit drop, drainage amounts, or total surgical time between the groups. We conclude that the use of a Blood Salvage drain should not influence the surgeon's preference on timing of tourniquet release in total knee arthroplasty.
Ernil Hansen - One of the best experts on this subject based on the ideXlab platform.
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A new approach for fat removal in a discontinuous autotransfusion device-concept and evaluation.
Vox Sanguinis, 2017Co-Authors: Timo Seyfried, M. Gruber, Michael T. Pawlik, S. Kasper, Richard J. Mandle, Ernil HansenAbstract:Background Fat present during Blood Salvage in orthopaedic or cardiac surgery can pose a risk of fat embolism and should be eliminated before transfusion. Based on observations of central fat accumulation at the bottom of Latham bowls, a fat reduction program was developed using two volume displacements, where Blood temporarily is removed and respun in the bowl to force the fat through the RBC sediment. Materials and methods Pooled ABO-matched RBC and FFP were adjusted to a haematocrit of 10%, and human fat tissue added to a concentration of 1·25 vol%. In six experiments, Blood was processed with the new-generation cell Salvage device CS Elite in a newly developed fat reduction program in bowls of three sizes. Volumetric quantification of fat was performed after centrifugation of Blood samples in Pasteur pipettes. From volumes, haematocrits and the concentrations of fat, RBC recovery and fat elimination rates were calculated. Results Fat removal rates of 93·2 ± 2·8, 97·0 ± 2·1 and 99·6 ± 0·3% were observed with a 70-ml, 125-ml and 225-ml bowl, respectively, and even higher rates when removal rates were calculated one cycle. At the same time, high RBC recovery and plasma elimination rates were maintained, not significantly different to the default program mode. Conclusion Modifications in process parameters and sequence led to a fat reduction program that significantly improves fat removal with the Cell Saver Elite from 77·4 ± 5·1% in the default mode to an average of 98·6 ± 1·1%, yielding results equivalent to the continuous cell Salvage system (C.A.T.S).
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processing of small volumes in Blood Salvage devices
Transfusion, 2014Co-Authors: Timo Seyfried, Anita Breu, Michael Gruber, Julia Reipert, Ernil HansenAbstract:Background New technical developments such as a small Latham bowl, a continuous autotransfusion system, and a dynamic disk designed for postoperative autotransfusion raise hopes for a possible application of Blood Salvage in young children. However, the minimal Blood volume for effective processing under clinically relevant conditions has yet to be determined. Study Design and Methods Fresh Blood from volunteer donations adjusted to a hematocrit (Hct) of 10% was used to test ELECTA (Sorin) equipped with a 55-mL bowl, C.A.T.S (Fresenius) in the pediatric program mode, and OrthoPAT (Haemonetics). Twenty-milliliter portions of red Blood cells (RBCs) were added and processed under various conditions, including clinically relevant first filling and intermittent emptying. RBC recovery and availability and plasma elimination were calculated from the Hct, free hemoglobin, and total protein. Results The main impediment to recovery and availability was the first filling. There, RBC recovery was significantly reduced, while it subsequently varied between 93 and 98%. To produce the first 30 mL of RBCs, ELECTA required 42 mL and C.A.T.S and OrthoPAT 62 mL owing to the dead space of the separation chamber or reservoir, respectively. RBC availability was much higher in subsequent processes, with only minimal differences between the three devices. They all consistently provided high plasma elimination rates. Conclusion The continuous system showed no advantage over a small Latham bowl. From the results it can be calculated that the limit for feasible cell Salvage at present is an infant of 6 months. All three devices are suitable for the processing of small volumes, but have the scope for further optimization.
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washing of banked Blood by three different Blood Salvage devices
Transfusion, 2013Co-Authors: Michael Gruber, Timo Seyfried, Anita Breu, Melanie Frauendorf, Ernil HansenAbstract:BACKGROUND: Storage lesions in red Blood cells (RBCs) lead to an accumulation of soluble contaminants that can compromise the patient. Organ failures, coagulopathies, and cardiovascular events including lethal cardiac arrest have been reported, especially with massive transfusion or in pediatric patients. Washing improves the quality of stored RBCs, and autotransfusion devices have been proposed for intraoperative processing, but these devices were designed for diluted wound Blood, and limited data on their performance with RBCs are available. STUDY DESIGN AND METHODS: Three autotransfusion devices (Electa, Sorin; CATS, Fresenius; OrthoPAT, Haemonetics) differing in function of their centrifugation chambers were evaluated with RBCs at the end of their shelf life and with dilutions thereof. Elimination rates of potassium, plasma free hemoglobin, total protein, citrate, acid equivalents, and iomeprol added as a marker substance were analyzed, in addition to RBC recoveries. RESULTS: Product hematocrit (Hct) levels ranged between 54.8 and 72.6%. RBC recovery rates were between 62.7 and 95.0%, the lowest being with the OrthoPAT processing of undiluted RBCs. Plasma elimination rates increased with predilution and ranged from 46.6% to 99.5%, the lowest being with the CATS and undiluted RBCs. Washing did not change pH and buffering capacity of RBCs. CONCLUSION: Autotransfusion devices offer a practical and obviously economical option to wash banked RBCs intraoperatively to prevent hyperkalemia and other disturbances in massive transfusion or pediatric patients. Predilution improves elimination rates, especially in devices that produce high product Hct levels. With a Y-tubing the RBCs should bypass reservoir and vacuum, and the procedure should be guarded by a policy and procedure manual and a quality management system.
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Blood irradiation for intraoperative autotransfusion in cancer surgery demonstration of efficient elimination of contaminating tumor cells
Transfusion, 1999Co-Authors: Ernil Hansen, Ruth Knuechel, J Altmeppen, K TaegerAbstract:BACKGROUND: Intraoperative Blood Salvage is contraindicated in cancer surgery because of contaminating tumor cells and the risk of systemic dissemination. On the basis of the radiosensitivity of cancer cells, irradiation of Salvaged Blood with 50 Gy is proposed as a way to allow return of Salvaged Blood. STUDY DESIGN AND METHODS: Elimination of tumor cells by Blood irradiation was studied in vitro with cells from 10 cell lines and from 14 tumor preparations after their addition to red cells in high numbers, or with Blood shed during cancer surgery. Before and after gamma radiation, tumor cells were isolated by density gradient centrifugation and tested for their proliferative capacity in a cell colony assay. DNA metabolism was analyzed by incorporation of 5′ bromodesoxyuridine. RESULTS: Survival curves of cells from various tumors confirmed D0 (the dose required to reduce the fraction of surviving cells to 37 percent of the original value) values in the range of 1.2 to 2.2 Gy. After irradiation of tumor cell-contaminated Blood with 50 Gy, no cell colony formation was observed, which indicates a reduction rate exceeding 10 log. Irradiated cancer cells showed viability, but no residual DNA metabolism. CONCLUSION: The level of inactivation by a 50-Gy dose far exceeds that needed to inactivate the number of proliferating tumor cells observed or expected in wound Blood. These results provide the experimental basis for the clinical application of Blood irradiation for intraoperative Blood Salvage in cancer surgery.
Manuel Munoz - One of the best experts on this subject based on the ideXlab platform.
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the cost of post operative shed Blood Salvage after total knee arthroplasty an analysis of 1 093 consecutive procedures
Vox Sanguinis, 2013Co-Authors: Manuel Munoz, Daniel Ariza, Arturo Campos, Elisa Martinmontanez, Jose PaviaAbstract:BACKGROUND: Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20-50%), and Salvage and reinfusion of unwashed, filtered post-operative shed Blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. MATERIALS AND METHODS: Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed Salvaged Blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed Blood collection canisters (Bellovac ABT, Wellspect HealthCare and ConstaVac CBC II, Stryker), shed Blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the Blood management cost analysis. RESULTS: Patients in the reinfusion group received 152±64 mL of red Blood cells from postoperatively Salvaged Blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs. 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed Salvaged Blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € -51.9 to € 49.9/patient for ConstaVac CBCII). DISCUSSION: Return of unwashed Salvaged Blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin <12 g/dL, although cost-saving, its efficacy could be increased by associating some other Blood-saving method.
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which patients are more likely to benefit from postoperative shed Blood Salvage after unilateral total knee replacement an analysis of 581 consecutive procedures
Vox Sanguinis, 2007Co-Authors: Manuel Munoz, Daniel Ariza, B Kuhlmorgen, E Haro, A Marroqui, G RamirezAbstract:Introduction Requirements for allogeneic Blood transfusion (ABT) after total knee replacement (TKR) are still high (30–50%), and Salvage of unwashed filtered postoperative shed Blood (USB) may represent an alternative to ABT. We evaluated that patients are more likely to benefit of USB reinfusion after TKR. Patients and Methods Data from 581 consecutive primary TKR, managed with (reinfusion group, n= 382) or without (control group, n= 199) reinfusion of USB, were retrospectively reviewed. Results Patients from reinfusion group received 119 ± 88 ml of red Blood cells from USB, without clinically relevant incidents, and showed a lower ABT rate (30.6% vs. 8·4%, for control and reinfusion groups, respectively; P = 0·001) (transfusion trigger, haemoglobin [Hb] < 9 g/dl). Differences in ABT rate between groups were significant for all preoperative Hb levels, except for Hb ≤ 12 g/dl. A lower transfusion threshold (Hb < 8 g/dl) might have further decreased ABT rate (14·6% vs. 5·2%, respectively; P < 0·001), with differences being significant for preoperative Hb between 12 and 15 g/dl. There were no differences with respect to postoperative infection rate, but patients from reinfusion group had a shorter length of hospital stay (11 ± 4 vs. 13 ± 4 days, respectively; P= 0·001). Conclusions Return of USB after TKR seems to reduce the need for ABT, especially in patients with preoperative Hb between 12 and 15 g/dl. There is little benefit of USB reinfusion for patients with preoperative Hb > 15 g/dl, whereas patients with preoperative Hb < 12 g/dl would probably benefit from the combination of USB with some other Blood-saving method.
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postoperative Blood Salvage and reinfusion in spinal surgery Blood quality effectiveness and impact on patient Blood parameters
European Spine Journal, 2000Co-Authors: C Sebastian, R Romero, E Olalla, C Ferrer, Juan J Garciavallejo, Manuel MunozAbstract:Although reinfusion of Salvaged shed Blood has become popular in major orthopaedic procedures, this Blood saving technique is still controversial. In an effort to assess the functional and metabolic status of shed Blood erythrocytes and the impact of postoperative shed Blood reinfusion on allogenic Blood requirements and patient’s Blood parameters, analyses of perioperative Blood samples were performed in 28 consecutive orthopaedic patients undergoing spinal fusion, in which postoperative shed Blood was collected and reinfused with the ConstaVac CBC II device. In comparison with a previous series of 31 patients, this procedure reduced allogenic Blood requirements by almost 30% (P < 0.05), without any increase in postoperative complications. Postoperative shed Blood presented lower haematological values and higher plasma-free haemoglobin (PFHB) levels than preoperative Blood, without any disturbance in morphology, median corpuscular fragility (MCF) or erythrocyte adenosine triphosphate (ATP) and diphosphoglycerate (DPG) content. Serum concentrations of enzymes – glutamate-oxalacetate aminotransferase (GOT), glutamate-piruvate aminotransferase (GPT), creatine kinase (CK), lactate dehydrogenase (LDH) – and inflammatory cytokines (IL-1β, IL-6) were elevated in shed Blood. After reinfusion, there was no alteration in coagulation parameters or cytokine levels. Serum levels of some enzymes increased at the end of surgery and remained elevated at postoperative day 2 (CK) or 7 (GOT, LDH), with a higher increase if postoperative autotransfusion was used as a Blood saving method. Therefore, caution should be taken when these serum enzyme levels are used for diagnosis. In conclusion, Salvaged shed Blood in orthopaedic procedures of the spine seems to be an excellent source of red cells which are not significantly damaged, keeping a normal functional and metabolic status, and reduces allogenic Blood requirements without significant side effects.
Venu M Nemani - One of the best experts on this subject based on the ideXlab platform.
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postoperative Blood Salvage and autotransfusion for adult spinal deformity a randomized controlled trial
Spine, 2020Co-Authors: Venu M Nemani, Curtis A Mina, Evan D Sheha, Thomas Ross, Han Jo Kim, Oheneba BoachieadjeiAbstract:Study design Randomized controlled trial. Objective The aim of this study was to determine whether postoperative Blood Salvage and autotransfusion versus traditional closed suction drainage reduces the rate of homologous Blood transfusions in patients undergoing surgery for adult spinal deformity. Summary of background data The use of intraoperative Blood Salvage has become commonplace in spine surgery; however, the collection and reinfusion of Blood drained from the wound postoperatively have not been employed routinely because of increased cost and questionable benefit. Methods Adult patients undergoing long posterior fusions were randomized to either a Blood Salvage and reinfusion system (OrthoPat - Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was Results Thirty-four patients were randomized into Group 1 and 36 patients into Group 2. There were no differences in preoperative or intraoperative parameters. Patients in Group 1 had higher hemoglobin levels on postoperative day (POD) 2 and POD 3 compared to those in Group 2. However, there was no significant difference in the percentage of patients requiring homologous Blood transfusion between the two groups (41% Group 1 vs. 60% Group 2, P = 0.17). Similarly a subgroup analysis in patients with estimated Blood loss >2000 mL also showed no difference in homologous Blood transfusion rates (67% Group 1 vs. 76% Group 2, P = 0.58). There were no differences in the rate or type of postoperative complications. Conclusion Postoperative Blood Salvage and reinfusion result in a higher hemoglobin level in the early postoperative period, but does not significantly reduce the need for homologous Blood transfusion. Level of evidence 1.
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post operative Blood Salvage and autotransfusion for adult spinal deformity a randomized controlled trial
Spine, 2019Co-Authors: Venu M Nemani, Curtis A Mina, Evan D Sheha, Thomas Ross, Oheneba BoachieadjeiAbstract:STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine whether post-operative Blood Salvage and autotransfusion vs. traditional closed suction drainage reduces the rate of homologous Blood transfusions in patients undergoing surgery for adult spinal deformity. SUMMARY OF BACKGROUND DATA: The use of intra-operative Blood Salvage has become commonplace in spine surgery; however, the collection and reinfusion of Blood drained from the wound post-operatively has not been employed routinely due to increased cost and questionable benefit. METHODS: Adult patients undergoing long posterior fusions were randomized to either a Blood Salvage and reinfusion system (OrthoPat - Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was less than 50cc over 4 hours, and drains were removed when output was minimal. Patients received autologous or homologous Blood transfusions when Hg 2000cc also showed no difference in homologous Blood transfusion rates (67% Group 1 vs. 76% Group 2, p = 0.58). There were no differences in the rate or type of post-operative complications. CONCLUSIONS: Post-operative Blood Salvage and reinfusion results in a higher hemoglobin level in the early post-operative period, but does not significantly reduce the need for homologous Blood transfusion. LEVEL OF EVIDENCE: 1.